Severe Hyponatremia Presenting with Minimal Symptoms

Abstract

Hyponatremia is a common electrolyte abnormality, however, encountering a patient with serum sodium level below 100 mEq/L and minimal symptoms is unusual. We present the case of an 86-year-old woman who was found to have serum sodium levels of 99 mEq/L. Her only complaint was difficulty in walking. On admission, and throughout her hospital stay, she did not have altered mental status, focal neurological deficits, or adverse outcomes. Her history, blood work, and urine studies pointed towards a diagnosis of thiazide-associated hyponatremia. Thiazide-associated hyponatremia can occur at any time during the course of thiazide administration. The first step that should be taken to manage this condition is discontinuing the medication. The lesson learned from this case is that the degree of hyponatremia does not always correlate with the severity of symptoms.

A Case Report of Atypical Hyponatremia Caused by Diarrhea Following a Course of Ferrous Sulfate Supplements

“…Risk factors include older age, low BMI, and female gender. In this patient, management included administration of 3% sodium chloride [12]. This prior case report demonstrates that consumption of a thiazide medication can lead to hyponatremia.…”

“…An interesting case by Lwanga et al (2017) investigated an eighty-sixyear-old woman who presented with serum sodium levels of 99 mEg/L, diagnosing her with hyponatremia. Initial complaints included difficulty walking.…”

Indapamide-induced Severe Hyponatremia in a Middle-aged Male Patient within Two Weeks

“…In this category, diuretic-induced hyponatremia, hypothyroidism, syndrome of inappropriate ADH secretion (SIADH) and psychogenic polydipsia were the differentials diagnosis [6]. As our patient was on diuretics, it is difficult to exclude SIADH in such scenarios as diagnostic criteria for SIADH include a diuretic-free period of at least one week [7]. Based on his medical history, clinical findings, and laboratory investigations revealing decreased serum sodium, potassium and chloride levels with high bicarbonate, diuretic-induced hyponatremia was the most likely diagnosis.…”

“…In literature, a case has been reported of severe hyponatremia dropping to a level of 99 meq/l in association with thiazide use in an elderly lady of 86 years with minimal symptoms [7].…”

“…The body is more prone to have hyponatremia with increasing age and therefore it is commonly seen in the elderly population [2,3,7,9,11,12]. Elderly population often have co-morbid conditions like multiple endocrinopathies, hypothyroidism, heart failure, chronic kidney disease, liver failure, hypertension, diabetes mellitus, multiple medications usage like diuretics, non-steroidal anti-inflammatory drugs (NSAIDs), tricyclic anti-depressants (TCAs), tea and toast diet with more water and less protein intake from many years and age-related decrease in glomerular filtration rate (GFR), all of which plays a crucial role in causing low sodium state chronically or even acutely [4,12].…”